There is much about fibromyalgia that we don’t know. It affects only two to four percent of people (more women than men) and there is no reliable test to detect the condition. Doctors diagnose fibromyalgia based on a patient’s relevant symptoms, such as widespread musculoskeletal pain, fatigue, as well as sleep, memory and mood problems. These symptoms may appear suddenly after a physical trauma, surgery, infection or psychological stress or develop gradually over time with no specific trigger.
WHAT DO WE KNOW? Fibromyalgia amplifies painful sensations by affecting the way the brain processes pain. Researchers believe repeated nerve stimulation causes the brain to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain. The brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, so they overreact to pain signals.
Fibromyalgia often co-exists with other painful conditions such as irritable bowel syndrome, migraine, painful bladder conditions, TMJ, anxiety and depression. It is also more common among people with diseases that affect the joints, muscles and bones, such as osteoarthritis, lupus or rheumatoid arthritis, although it is not thought to be an autoimmune or inflammation based illness. A person with a family history of fibromyalgia is more likely to develop the condition.
DIAGNOSIS Diagnosing fibromyalgia can be tricky because symptoms often overlap those of other conditions. In the past, doctors would check 18 specific points on a person’s body to see how many of them were painful when pressed firmly. Newer guidelines don’t require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months – with no underlying medical condition that could cause the pain. If he or she suspects a diagnosis of fibromyalgia, a primary care physician may refer the patient to a Rheumatologist, a specialist who is trained to treat arthritis and other similar conditions.
Patients can help their physician by having some important information ready to discuss during the appointment. Bring along the following:
The doctor also may ask if you have had problems sleeping, find it difficult to concentrate and stay focused and if you have been anxious or depressed.
TREATMENT OPTIONS While there is no cure for fibromyalgia, there are medical and non-medical treatments that can reduce the symptoms.
NON-DRUG THERAPIES One of the most effective treatments for fibromyalgia is regular aerobic exercise. Another type of therapy recommended to reduce pain and other symptoms is Cognitive Behavioral Therapy or CBT, which focuses on how thoughts and behaviors affect pain. Other complementary and alternative therapies (also known as CAM or integrative medicine), including acupuncture, chiropractic and massage therapy, may be effective in fibromyalgia pain management. For best results, people with fibromyalgia should use non-drug treatments as well as any medicines their doctors prescribe.
MEDICATIONS The FDA has approved several drugs for the treatment of fibromyalgia symptoms. Medications such as Cymbalta, Savella Elavil and Flexeril change some of the brain chemicals to help control pain levels. Other drugs like Lyrica and Neurontin work by blocking the over activity of nerve cells involved in pain transmission.
The American College of Rheumatology strongly recommends against the use of opioid narcotic medications for treating fibromyalgia. The reason for this is that research evidence shows these drugs are not helpful to most people with fibromyalgia, and may cause greater pain sensitivity or make pain persist.
FIBROMYALGIA MISCONCEPTIONS Many people think fibromyalgia isn’t a real medical problem or that it is “all in your head.” There’s a lot that’s unknown about fibromyalgia, but researchers have learned more about it in just the past few years. The good news is that as more is known about this mysterious, and often misunderstood condition, the more can be done to relieve the symptoms and help people who have fibromyalgia improve their overall quality of life.
Sources: The American College of Rheumatology; Mayo Clinic.